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Research Questions

  1. What did interviews with representatives from the participating counties say about the strengths and weaknesses of the FSP Innovation Project, perceived effects, barriers and facilitators, and lessons learned?
  2. What do electronic health records and program data say about the impact of FSP programs on participant outcomes? Has this impact changed over time as a function of participating in the FSP Innovation Project?

In 2020, an initial group of six counties began participating in the California Multi-County Full Service Partnership (FSP) Innovation Project, with goals of identifying a shared understanding of its core components, improving consistency across FSP programs, and developing or enhancing operational processes that are data-driven and outcome-oriented. Fresno, Sacramento, San Bernardino, San Mateo, Siskiyou, and Ventura counties established a collaboration model that fostered peer learning and county cooperation to enhance FSP programs and to inform the design of FSP program innovations. 

This report describes the evaluation of the FSP Innovation Project. The authors' evaluation—covering the period directly following innovation implementation at the end of 2021 through 2023—had qualitative and quantitative components. The authors collected and analyzed data from semistructured, qualitative interviews with representatives from the participating counties and analyzed quantitative electronic health records and program data.

Overall, there is evidence that the FSP Innovation Project led to improvements in processes and outcomes among the first cohort of participating counties. Counties worked with each other and a nonprofit to successfully implement standardized definitions, measures, guidelines, and processes necessary to improve program implementation. However, there was considerable variation in the extent to which innovations were implemented on the ground and sustained after the initial innovation development and implementation period was over. Nonetheless, the authors found evidence that FSP participants experienced improved outcomes in key areas, including stable housing, justice system involvement, and psychiatric hospitalizations, and that these improvements increased after counties participated in the FSP Innovation Project.

Key Findings

  • The initial cohort of six counties participating in the FSP Innovation Project successfully developed standardized definitions for key populations served, as well as common process and outcome measures. A subset of the counties succeeded in developing program step-down and graduation guidelines, improved data collection processes, and referral guidelines or processes.
  • After the initial development of planned changes to the FSP programs, the extent of on-the-ground implementation and sustainment varied by county and by innovation area.
  • Outcomes for FSP participants improved during the first 12 months of involvement. Participants experienced reduced psychiatric inpatient admissions, increased stable housing, and decreased judicial system involvement.
  • Improvement in individuals' outcomes increased after participation in the FSP Innovation Project, suggesting that the project facilitated improved quality of care.

Recommendation

  • Given the initial successes of the FSP Innovation Project and the lessons learned about its implementation and impacts, it may be helpful to expand the innovations to additional counties across the state—with attention to such issues as need for provider training in the innovations and step-down care options.

Research conducted by

This research was funded by the California Mental Health Services Authority (CalMHSA) and carried out within the Access and Delivery Program in RAND Health Care.

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

RAND is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.